Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

Working With Babies Of Any Age

Illustration about what it feels like to go back to work by David Rosenman

Leaving anyone we love is fraught with duplicity. While we feel the tug of distance, we have the fortuitous lens to see two things at once: the treasure of the bond forged and the aching feeling of distance when it’s gone. This binocular into our lives inspires joy but it also occasionally does bear weight. I’ve often said that leaving my babies (now children, but let’s be honest they’re always my babies) and going to work feels a little like walking around without a limb or without a necessary body part. Without them around something essential is glaringly absent. At times thinking on them is wildly distracting, especially right at first.

Up there, look at that graph. Haven’t you had days like this?

The fortune in raising and loving children is that we’re continually reminded of these dual realities. Life after a baby is forever transformed; as parents we are never again simply singular. Or at least as I see it, we’re not entirely whole again when alone. When we meet our babies big real estate in the heart is rapidly taken up by our children and although wandering, working, traveling away, and seeking new experiences is essential to our personal evolution, we do always seem to notice the absence of our babies when we’re apart. I’m coming to know this is true at any age. Read full post »

Power Of A Google Search: Community

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2-year-old Addison Hyatt survived a  pediatric stroke at birth. (Image courtesy: Kaysee Hyatt)

One Google search can sometimes change everything.

After learning something new about our child’s health or condition, especially for worried parents and caregivers, leveraging online search as a resource in diagnosis, clarification and education is typical behavior. Searching out support, camaraderie and tips online just makes sense. In fact, 2013 data from the Pew Research Center finds that 1 in 3 Americans goes online to search for information and support in finding a diagnosis. If you’re a woman, college-educated, or younger (under age 49) the likelihood of searching online increases and approaches 50%. Not only are we searching for health info and connection online, we’re doing it more so with mobile devices. Pew data from April 2015 finds that 64% of Americans have a smartphone and that 6 in 10 are searching for health info on a mobile device.

That smartphone in your pocket can connect you to information yes, but also to others like you.

Of course most clinical care still happens in the office and most decisions, especially important ones, are made offline. Yet preparing for visits, strengthening resolve, finding other parents in similar situations can potentially improve the way we care for and raise children with underlying medical challenges. It can also change how we feel about it. In my mind, one of the most precious resources will always be the people. This includes our family, our nurses, our therapists, our relatives, our clinicians and our peers. In the words of Susannah Fox, a technology and health researcher who is now Chief Technology Officer at the U.S. Department of Health and Human Services, when it comes to caring for yourself or others in your life, “Community is your superpower.”

I’m still the doctor who encourages online search, especially when looking for resources in networked communities. Social networks have simply shrunk the distance between us and facilitated robust connection. Finding others like you, who’ve been down the road before you, can often provide support, help reduce anxiety, provide tips and connect you with resources you didn’t even know existed. As a pediatrician, there’s no question that expert patients and their families often teach me about resources available to them I’ve not previously known — as a clinician I’m grateful. Once I review the sites and organizations, I can then share those communities and education sites with other patients I’m lucky enough to partner with.

Community is your superpower   ~Susannah Fox

Mom Kaysee Hyatt drives this point home. After months of concern surrounding her infant daughter’s delayed development, Kaysee Hyatt finally got the diagnosis: her daughter Addison had suffered a perinatal ischemic stroke at birth. After receiving the news, Kaysee was told to go start therapy but in her words “there really was no plan.” Out of curiosity and intent, she turned to the Internet. A Google search on pediatric stroke led her to CHASA.org (Children’s Hemiplegia and Stroke Association), a nonprofit group founded by parents that provides resources and dozens of discussion groups for families dealing with pediatric stroke. Kaysee told me that when she found the site and learned more, “It changed everything.” When talking with Kaysee what stuck with me most is how Kaysee’s sense of isolation dissolved when she found these resources online. She remembers that she was stunned to find so many families with strikingly similar stories to her own. “It was amazing,” she told me, “we all shared the same stories.”

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Disneyland Success Story During Measles Outbreak

baby-O-e13075541951481There’s a beautiful story of success tucked away in the recent measles outbreak in the United States. Sometimes we forget to talk about it. When measles popped up at Disneyland in December 2014, it made headlines as the public remained thirsty for the media’s support in understanding who was at risk and why. I spoke to dozens of media outlets about the outbreak, under-vaccinated populations, the MMR vaccine, and how to protect those most vulnerable during an outbreak. We all emphasized those at biggest risk: infants too young to be immunized, those who were unvaccinated, or those too ill to be vaccinated. Measles is an illness I would be terrified to get — and I don’t like that people who aren’t protected are at risk for both catching the disease and spreading it. I think the public gets this in new ways although I hate that it takes outbreaks to capture attention and drive this education and understanding.

Measles virus, and the vaccine we have to prevent it, form a unique pair because although measles is wildly infectious and can be life-threatening the immunization is wildly effective and life-saving (>99% of those immunized are protected for life). It is a safe vaccine with minimal side effects. What a fortune and a triumph in prevention medicine. A terrible disease, once thought to be eradicated in the U.S., is swiftly prevented by a vaccine that nearly everyone in the population can get after their 1st birthday.

The beautiful story from the outbreak is this: Read full post »

Pale4Prom: Indoor Tanning And A Hashtag

Image courtesy: @mdub686 (Original source found here)

Image courtesy: Melissa Walling (Original source found here)

It’s prom season and we all know it’s the season where teens feel pressure (and sometimes giddy delight) to prepare to look entirely fabulous for the night. Full of pressure or full of glee, this is without a doubt the time of year when teens I see in clinic talk most about tanning.

A 2014 JAMA study found 19% of teens (under the age of 19) have used a tanning bed, with 18% of them stating that they’ve used one in the last year. That’s in every teenagers still feeling that “bronzed is better” and a thing of youthful beauty regardless of the known consequences. We have to do a better job, both as parents and as doctors and health educators, explaining the unnecessary risks teens take on when changing the color of their skin. Recently, a hashtag surfaced on social media encouraging teens to be “#pale4prom.” Thoughtful critics have raised concerns about the racial implications this campaign could ignite, I do feel this campaign can do good for those teens exploring indoor tanning. We all want to feel beautiful in skin that is protected from the sun. In my mind, the easiest word to market the idea of skin without sun is pale. I’ve urged teens to enjoy the beauty of pale skin (sometimes unsuccessfully, in clinic and in my personal life) and hope the shift from bronze to pale is a trend that continues to grow as years unfold. There’s no question we can do a better job valuing what beautiful skin really is. 5 reasons why: Read full post »

Pill Swallowing Sooner Than You Think

4-20 pill tongueAs adults, many of us take or swallow pills out of necessity to manage or prevent a chronic health condition. From a vitamin to even a life-sustaining medicine, you probably don’t hesitate or panic when swallowing the pill, even the biggies. But knowing how to swallow medicine isn’t something that just happens, often it’s a learned skill that may vary widely in regards to timing. During my education I was trained to think that once children hit double digits (age 10 years) it’s appropriate to think of them as “capable” of swallowing pills. But new findings published in Pediatrics cite research demonstrating that learning how to swallow a pill may be easier for younger children to master before they’re facing anxiety that can come from having to swallow something whole. Bottom line in the research: although many children struggle with swallowing pills, five studies reviewed find various techniques to support children with pills really do work! Mastery is possible here, but anxiousness about pill-taking spans childhood for some. Unease about pill taking can be a real barrier in treatment adherence both for children and teens with chronic health conditions.

Pill-swallowing may not come “naturally” to your child. A 2008 survey found more than 50% of children, by parental report (children from birth to age 26), were unable to swallow a standard size pill at some point. This complexity in pill-swallowing or refusal of medicines can be a once-in-a-while battle or a daily barrier at home. Many important medications are taken orally and the illness experience for parent and child is much more stressful when this challenge pops up.

Interventions Do Help

Five interventions were reviewed in the research and all of them proved beneficial for children: Read full post »

Mindfulness In A High Stakes Job

4-17 mexicoWe’re just back this week from a vacation with our children. The 6 days we had together, the variant pace at which we were able to live for the week, and the challenges that bubbled up offered some reminders but also some fears for me. We’re always on quicksand while raising children. Parenting demands exceptional grace but also exquisite flexibility and immediate rapid-fire insight. Our job descriptions, as parents, are ever-evolving; we’re asked to shift what we know as we step from stone to stone and into something new as quickly as our children do. The minute we feel we’ve figured something out — whammo — a new challenge arises we never even thought to consider.

The stakes are high. Of anything that unites us all as parents it’s knowing that truth. Along the way we will fail, fail, fail and have wondrous little successes too, thank goodness. Yet the tasks involved in raising a child will never look just like they did last month. I loved a This American Life (#553) segment I listened to this past week where a mom discussed some of the complexities in the requisite shifts she faced raising a principled little 7 year-old boy named Elias who is vegetarian and very emotional about animal-eaters. He finds himself living amid a family who explores an occasional pepperoni pizza and turkey sandwich. As his parents upend the way they eat at home (they end up banning all meat at home because of their son’s feelings) narrator Ira Glass states,

“If you’re hearing all this and you are feeling judgey about these parents and I know you are, because that is a national pastime — judging other people’s parenting – I just want to say I totally felt that way until I heard Elias….just like she says. Hearing Elias made me realize ‘oh, right, she actually is in a really tough situation. Where she has these two kids and those both have really strong feelings about this and she doesn’t want to crush either one of them.’”

Judging others’ parenting is often just the malaise of parental insecurity. We all have our own shakiness at times, especially as we’re asked to rise to new heights each new day. It’s of course so easy to judge, and so much harder to elevate and emulate others. In my mind, the best we can do while parenting (failing or succeeding) is tease out others’ profound moments. Learn from them but also copy and try those things out ourselves and see how we can make them work in our own lives. Read full post »

When Recess Is The Favorite Subject

4-13 recessMost parents cringe in the office or at the park when their child reports to me that recess is their favorite subject. Thing is, I think they may want to celebrate. Some of our best thinking, our most inventive or creative solution generation, happens when moving around outside. Research has validated the merits of play and movement for learning during the past decade and educators and pediatricians have risen up to exalt the time our children spend twirling around between math and social studies. It’s time to get excited about recess before we lose focus that it’s not just healthy weight we’re fighting for — this is about promoting healthy minds, bountiful creativity, and skills for connection too.

Tips To Advocate For Protected Recess & Play

  • White Space: I think of recess as a part of the white space we serve up for our children in life. That time and space to dream, elaborate, and enjoy whimsy in our minds. We cannot forget the value that reflection and exercise has on the creative process. When talking with your school educators and when designing a day with children make sure there are “pockets of stillness” (see #4 here on Brain Pickers) but also white space for loud iteration. No question in my mind that movement aids learning. Think of all the things you discover while going for a walk, a run or even the epiphanies you discover while taking a shower.
  • Join Forces: PTA/Lunch & Recess Matter Group. Band together with like-minded parents and educators. In the Puget Sound area, for example, only the Tacoma School District mandates a certain amount of time for recess and play. Join forces with Lunch & Recess Matter Group to re-prioritize this play and learning if it’s not happening at your school.
  • Social and emotional well-being matter (more on this later this week): Although we all want our children to have an education that affords endless opportunity (we want our children ready to be brain surgeons, artists, stay at home parents, educators, or entrepreneurs), we must remember how the time spent while playing and relating with peers may be most essential to creating pluripotent opportunity.

 Data On Recess And Play

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How To Safely Dispose Medications & One Thing NOT To Throw Away

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Getting rid of unused medications is something all of us do at some point or another. How to do it safely, though, is another story. Typical parenting moment: you reach into the medicine cabinet for vitamins or you’re hunting for ibuprofen or acetaminophen for a child’s fever and you grab a bottle of medication that, on closer examination, has an expiration date from several years ago. You realize you won’t use it. Before you toss that bottle in the trash, there are some safety precautions you can take to ensure the medication doesn’t end up in your sewer water, water source, or worse, in the hands of a curious toddler looking for treasure in the garbage can. The FDA provides detailed instructions on how to properly dispose of medications, but for the busy parent in all of us, there are three key takeaways:

1. MIX the medicines with things that bind

Take a bag of coffee grounds or kitty litter and dump the medication into it. The medication will bind with grounds or litter and be less likely to leak or spill out of the garbage once disposed. This method also discourages those curious little fingers (and hungry pets) from ingesting or getting into the medication!

2. SEAL the mixture in a container

Make sure your kitty litter/medication mixture is properly sealed in a sealed plastic sandwich bag or a take-out food container with a sealed lid before throwing in the trash.

3. THROW the mixture away

Now you’re okay to throw the medication (and binder) into the trash safely. Don’t flush medications in the toilet or dump them into a body of water of any kind.

The One Thing You Shouldn’t Toss:

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Balance And Bad Parenting, Maybe

3-27 jumpingLast night four Swansons sat in row 6 of a little commuter airplane on the way to visit family, all plugged in. Four people who love each other with four separate devices hardly communicating for the two hours or so that we sped through the air. At first glance it can look like an utter failure — you can hear the criticism ringing in your ears — this family must not be connected, or these working parents, pounding out emails and prepping presentations while their children watch videos and play apps, really must have their priorities off, right? Right.

Maybe.

On that flight I read a beautiful blog post from tenacious pediatric researcher Dr Jenny Radesky that questions the new world in which children are being reared. The one where their parents are plugged-in, distracted, perhaps less attentive and less available while raising infants and young toddlers. It’s the same world today, where preteen digital natives may be connecting more by text than by talking. She cites data that found, “if you take away preteens’ mobile devices and make them hang out with their peers in the country for one week, they get better at reading other people’s facial expressions.” Perhaps these children and teens are swapping thumb skills for interpersonal ones. Radesky is the researcher behind the observations out last year evaluating parents’ use of mobile phones at dinner that alarmingly demonstrated children’s near need to act out to get their parents’ attention.  Are our parent-child connections forever changed because of the profound brilliance that digital devices have in capturing our attention? Radesky brings up the zone of proximal development (I’d not previously heard of it) and its profound value. She says,

In order to effectively teach children how to regulate their behavior, we need to interact with them in what psychologist Lev Vygotsky termed the child’s “Zone of Proximal Development (ZPD).”  This means  knowing their cognitive and emotional sweet spots: what they can do on their own, what they can’t do, and what they can do and learn with an adult’s help.  You can’t fit the puzzle pieces in yet?  Let me guide your hand a little bit until you figure it out by yourself. You can’t calm down when you’re frustrated yet. Let me help you identify what emotion you’re feeling and then show you some options for calming your body down. And I’ll slowly take my support away until you can do this skill on your own.

Oh yes, we certainly do need to be in this space and be available, eyes connected, body engaged, actively listening to the loves of our life (children). In championing this reality we can easily finger-wag that how things used to be (without smart phones and wild virtual connection to data and community) is better. Slow down, unplug, unwind, and CHECK BACK IN, right? Common Sense Media even has a new PSA campaign, that I happen to love, tagged #realtime guiding us back to life with a series of delicious, tight videos reminding us how we mess up. Read full post »

E-Cigs And A Free App To Help Quit Smoking

Last week a proposal was introduced that would give Washington State the toughest e-cigarette laws in the country. If passed, House Bill 1645 would significantly raise the taxes on e-cigarettes, ban the sale of flavored vaping liquids, ban online sales to Washington residents and require producers to list ingredients on labels. And while opponents of the bill argue that e-cigarettes are “healthier” than tobacco, there’s no denying the dangers of having such a highly addictive substance in arm’s reach to children and teens in an unregulated manner. Washington isn’t the only state taking action. This week California released a campaign calling out marketers of e-cigs for targeting teens. Teens are using e-cigs more and more with 1 in 5 high school sophomores here reporting having used them in the last month. E-cigarettes and e-hookahs may carry an illusion of safety they don’t warrant.

What House Bill 1645 Proposes

  • Instill a 95% tax on vaping products similar to tobacco product taxes
    • Right now only North Carolina and Minnesota have imposed taxes on E-cigarettes
  • Make it illegal to sell flavored liquid nicotine or other vaping fluids
  • Ban internet sales to Washington residents
  • Require ingredients list on all labels

Curbing An Urge To Smoke: An App For That

Supporters of e-cigarettes and those fighting against regulation often claim the devices are helpful in helping tobacco users quit, so-called harm reduction. I certainly won’t and can’t argue with anecdotes that this is useful for those wanting to quit. While this concept hasn’t been entirely disproved or entirely proven, there is still a lot we don’t know about vaping and the effects of liquid nicotine. If you or someone you know wants to quit tobacco, there are some new digital resources available to help you kick the habit. The good news is we can be hopeful that dual-pronged approaches may help those wanting to quit earnestly succeed. Download this app?

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Image courtesy: Washington Department of Health

Washington State residents have access, for a limited time, to a free app called SmartQuit. Sponsored by the Department of Health, the app is a tobacco cessation program that proved three times more effective than trying to quit on your own, according to a recent study from Fred Hutchinson Cancer Research Center. SmartQuit users create a personal plan to become aware of their urges to smoke, they then learn new ways of thinking about those urges to suppress the desire to smoke. The Washington Department of Health is offering the app for free to a limited number of users. Because the funding is limited, please don’t download unless you’re serious about using the app as the number of free downloads will run out. Consider it? If you or someone you know does, report back on your opinions?

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